Opinion
No. C99-1005
October 9, 2002
ORDER
This matter comes before the court pursuant to trial on the merits. At trial, the plaintiff was present and represented by Michael Shubatt. The defendant was represented by Sean McPartland. The court finds in favor of the defendant and directs judgment to be entered accordingly.
This is an action for long-term disability income benefits pursuant to the Trilog, Inc. Insurance Plan with the Life Insurance Company of North America. The plaintiff contends that she met the definition of disability due to her long-term problems with depression. Trilog contends that the plaintiff was not disabled within the meaning of the plan and that the medical evidence submitted on her behalf only shows an inability to work for one particular employer. The court makes the following findings of fact and conclusions of law.
FINDINGS OF FACT
Plaintiff Lea K. Sullivan is 55 years old. She holds a bachelor's degree in business from Loras College in Dubuque which she earned in 1987. She graduated magna cum laude and was in the top 5% of her class.
Following her graduation, Ms. Sullivan worked a short time at Venture stores as an assistant human resources manager. Following that employment, she went to Trilog. Trilog is a division of CIGNA Insurance. Trilog administers 401K plans for numerous companies throughout the country.
Plaintiff was hired by Trilog on April 8, 1991, as a plan analyst. A plan analyst performs monthly and annual evaluations of 401K plans. It is the plan analyst's job to make sure that all investments within the plan comply with federal regulations. In plaintiff's position, she would use four separate computer systems. When a company would send in monthly contributions for employee retirement plans, it would be up to Ms. Sullivan to make sure that the money was invested pursuant to the employee's particular designations. The plan analyst also works with communication analysts who contact the client directly for purposes of education and compliance. Ms. Sullivan also devoted a significant amount of time to the research of problems caused by incomplete forms or errors in processing information. Approximately one-half of Ms. Sullivan's time was spent interacting with other people at Trilog and the other half was spent at the computer. The job description for the plan analyst can be found in the record as Exhibit 2.
The plaintiff found her work at Trilog very stressful due to the volume of work and what she considered to be a lack of organization at the company. The plaintiff also found it stressful because of the time deadlines, the regulations, and missing information that was difficult to find.
The plaintiff suffers from chronic major depression and borderline personality disorder. She was first diagnosed with depression in the 1970s. The borderline personality disorder was first diagnosed in the 1980s. The plaintiff's description of her major depressive episodes shows this problem to be debilitating at times. She has been treated by Dr. Thomas Boxleiter since the early 1980s. She has taken a number of medications over the years and will continue to be on medication for the rest of her life.
In 1994 she had to endure electroshock therapy. It caused her to lose significant memory of events. Plaintiff was off work for nine months. She applied for and received both short term and long term disability benefits from June of 1994 through February 14, 1995. Dr. Boxleiter stated in September of 1994 that she was totally disabled both from her regular occupation and from any occupation for an indefinite amount of time. That diagnosis continued through October of 1994 even though he believed that she would later return to full-time employment. The plaintiff returned to full-time employment on February 20, 1995. She returned to her job as a plan analyst.
In 1997, the plaintiff began experiencing more anxiety and problems at her employment. Her last day of work for Trilog was June 9, 1997. She remained an employee of the company but was terminated on May 13, 1998, upon the expiration of her medical leave.
On June 10, 1997, she received a work release from Dr. Boxleiter's partner. The work release stated that she was to be reevaluated on June 26, 1997, to determine when she would be able to return to work. She received short term disability benefits under the company's policy from June 10, 1997, through September 5, 1997. Her request for long-term disability benefits was denied.
The plaintiff was unemployed until April of 1998 when she obtained a job as a financial counselor in Dubuque working approximately 20 hours per week with persons who were having financial difficulties. She worked at that position for approximately one year but ultimately found that there was not enough work to do. After that, she worked for a temporary agency doing clerical work. At the time of trial she was not employed.
Dr. Boxleiter testified at length in his deposition about the nature of the plaintiff's disability in the summer of 1997. In August of 1997, he wrote in his records, "Disabled from her own job permanently. May seek other employment." At his deposition, Dr. Boxleiter testified that the plaintiff was feeling so frustrated and badgered that he did not feel it was appropriate for her to go back to her job but Dr. Boxleiter felt that it was important for her to seek other employment. (Boxleiter Deposition at 16 and 46). In fact, he thought she should return to work "ASAP."
QUESTION: And that meant that you wanted her to try and find a job as quickly as she could because you thought it would be helpful to her?
ANSWER: Yes.
QUESTION: And that would include a job that might include the same duties as she might have been doing just so long as she was not doing it at Trilog; is that accurate?
ANSWER: Correct.
(Boxleiter Deposition at 47 and 62).
The plaintiff's request for long-term disability benefits was processed at CIGNA Group Insurance. It was first processed by case manager Lynn Casella. Ms. Casella reached the conclusion that Dr. Boxleiter was indicating that plaintiff could perform her occupation but just not for Trilog. (Casella Deposition at 16-17). As a result of that denial, the decision was appealed to Paul Haberstock. Mr. Haberstock is the Chief of Staff at the Life Insurance Company of North America's Pittsburgh claim office. He interpreted the disability policy's reference to "regular occupation" as a reference to that occupation as it would be performed in the national economy rather than at a particular employer. (Haberstock Deposition at 7-8). Mr. Haberstock reviewed the letter from the plaintiff's attorney together with the medical report of Dr. Boxleiter dated September 26, 1997. He requested that plaintiff's lawyer send copies of any additional medical information from June of 1997 until the date of the review. Mr. Haberstock found that the plaintiff could not return to Trilog because of anxiety that she experienced there but that she was not disabled from performing that same occupation in another location. (Haberstock Deposition at 9-10). On February 5, 1998, plaintiff requested further review.
The decision was appealed to Jeffery Smith who was a senior case manager at the Life Insurance Company of North America. He received the appeal from Mr. Haberstock and was to evaluate any additional information that was submitted to determine if the previous decisions should stand. He wrote to Trilog and requested a job description for the position of plan analyst as well as physical demand forms. (Smith Deposition at 8). He sent the job description to Dr. Boxleiter and asked what would prevent the plaintiff from performing those same duties at another employer. He received a letter from Dr. Boxleiter dated March 17, 1998. (Exhibit A at 108). Again, from this information, Mr. Smith concluded that Dr. Boxleiter was stating that the plaintiff was not disabled from the occupation of plan analyst but only could not work for Trilog. (Smith Deposition at 11).
The policy at issue provides that:
An Employee will be considered Disabled if because of injury or Sickness he is unable to perform all the material duties of his regular occupation; and after Monthly Benefits have been payable for 24 months, he is unable to perform all the material duties of any occupation for which he is or may reasonably become qualified based upon his education, training or experience.
CONCLUSIONS OF LAW
The court reviews the denial of the benefits in this case under a de novo standard of review. Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 111 (1989). The court must give language from the plan its common and ordinary meaning as a reasonable person in the position of the plan participant, not the actual participant, would have understood the words. Barker v. Ceridian Corp, 122 F.3d 628, 632 (8th Cir. 1997) (cited in Melvin Yale Industrial Products, 197 F.3d 944 (8th Cir. 1999)). When interpreting the benefits provisions of ERISA regulated insurance plans, courts are guided by federal substantive law. Baker v. Provident Life Accident Ins. Co., 171 F.3d 939, 942 (4th Cir. 1999). The language of the plan itself, of course, is paramount in this endeavor. Id. The court is not at liberty to rewrite the provisions to suit sympathetic situations. Davolt v. O'Reilly Automotive Tools, 206 F.3d 806, 810 (8th Cir. 2000).The primary issue in this case is the manner in which the term "regulation occupation" is to be interpreted in light of the evidence as it came primarily from the plaintiff, her husband, and Dr. Boxleiter. In interpreting an occupational disability insurance policy, the term "regular occupation" should be construed to mean a position of the same general character as the insured's previous job, requiring similar skills and training, and involving comparable duties. Kinstler v. First Reliance Standard Life Ins. Co., 1997 WL 401813 (S.D.N.Y. 1997). Such a definition steers a sensible middle course between the extreme definitions of "regular occupation," as, on the one hand, one's particular job with a particular employer, and, on the other hand, "the principal business of one's life." Id. See also Thomas v. Lockheed Martin Information Systems, 155 F. Supp. 1316 n. 6 (N.D. Fla 2001) (employee's "regular occupation" was senior support engineer or electrician, regardless of his specific employer).
The term "occupation," when given its ordinary meaning, has nothing to do with the particular employer and everything to do with a set of required skills. Modifying the term "occupation" with the term "regular" does not convert occupation into a reference to a specific employer.
This court believes Dr. Boxleiter's testimony as set forth in the text above. Dr. Boxleiter made it clear that plaintiff could return to her occupation as a plan analyst but simply could not return to Trilog. This is clearly the most objective and credible testimony in the record. Upon de novo review of the denial of benefits, the court agrees with Trilog.
Upon the foregoing,
IT IS ORDERED
That the court finds in favor of the defendant and against the plaintiff. Judgment shall be entered accordingly.